Soc Sci Med. 1995 Mar;40(5):657-67. doi: 10.1016/0277-9536(95)80010-h.
Situation analyses were conducted by 11 multidisciplinary teams in the West African Prevention of Maternal Mortality (PMM) Network, with technical assistance from Columbia University's Center for Population and Family Health. Data on the functioning and use of facilities were used to identify resource needs and management problems at facilities providing emergency obstetric care in Ghana, Nigeria and Sierra Leone. The researchers looked at the number and distribution of facilities, trends in utilization patterns, time from admission to treatment at facilities, functioning of referral systems, availability of essential supplies, staffing patterns, and staff perceptions of services. Research methods included patient flow studies, inventories of drugs and supplies, and retrospective reviews of hospital records. Qualitative information was also collected through interviews with staff. This paper summarizes the principal findings of the situation analyses. Normal deliveries fell markedly where users' fees were initiated. However, the number of women with complications seen increased at several of these sites. The lack of drugs and supplies at the facilities had an adverse effect on utilization of non-emergency services and on women's survival chances. Users' fees and unavailability of supplies contributed to unacceptably long waiting times between admission and treatment at most sites. These long waiting times were also found to be associated with higher case fatality rates. Staff-to-patient ratios at the sites improved or remained stable, and do not appear to be associated with changes in quality of care. Strategies to address the problems identified include: the establishment of small revolving fund schemes to ensure the availability of supplies; the creation of 24-hr pharmacy services; the establishment of on-call rooms for staff; and the improvement of staff attitudes and morale through various types of training activities. These situation analyses were useful for assessing health system factors contributing to maternal deaths. The information on complicated cases and on hospital functioning provided a marked improvement over previous studies limited to data on deliveries and maternal deaths. Low-cost techniques such as the patient-flow studies and drug and supply inventories provided valuable information which was easily intelligible to program planners. These types of studies are recommended for use prior to the development of projects designed to reduce maternal deaths.
西非孕产妇死亡率预防（PMM）网络中的11个多学科团队在哥伦比亚大学人口与家庭健康中心的技术援助下进行了情况分析。关于设施运作和使用的数据被用于确定加纳、尼日利亚和塞拉利昂提供紧急产科护理的设施的资源需求和管理问题。研究人员考察了设施的数量和分布、利用模式的趋势、从入院到在设施接受治疗的时间、转诊系统的运作、基本物资的可用性、人员配备模式以及工作人员对服务的看法。研究方法包括患者流量研究、药品和物资盘点以及医院记录的回顾性审查。还通过与工作人员的访谈收集了定性信息。本文总结了情况分析的主要结果。在开始收取使用者费用的地方，正常分娩显著减少。然而，在其中几个地方，出现并发症的妇女数量有所增加。设施中药品和物资的短缺对非紧急服务的利用以及妇女的生存机会产生了不利影响。使用者费用和物资短缺导致大多数地方入院和治疗之间的等待时间长得令人无法接受。这些漫长的等待时间还被发现与更高的病死率相关。这些地方的医护人员与患者比例有所改善或保持稳定，并且似乎与护理质量的变化无关。解决所发现问题的策略包括：设立小型周转基金计划以确保物资供应；设立24小时药房服务；为工作人员设立值班房；以及通过各种培训活动改善工作人员的态度和士气。这些情况分析对于评估导致孕产妇死亡的卫生系统因素很有用。关于复杂病例和医院运作的信息比以前仅限于分娩和孕产妇死亡数据的研究有了显著改进。诸如患者流量研究以及药品和物资盘点等低成本技术提供了有价值的信息，项目规划人员很容易理解这些信息。建议在开展旨在降低孕产妇死亡的项目之前进行这类研究。
